Included in the classification of vascular disorders that arc often confused with masticatory pain arc migraine headaches. Migraine is an idiopathic, recurring headache disorder that occurs in attacks that may typically last from 4 hours to as many as 3 days. This headache is usually unilateral, moderately severe, and pulsating in quality. Migraine is generally aggravated by routine physical activity and may be associated with nausea, photophobia, and phonophobia. It is not uncommon for the migraineur to seek a dental consultation for relief from what is perceived to be dental or masticatory musculature pain.Migraine with aura has similar characteristics, as does migraine without aura. The difference in this case is that the headache is normally preceded by a preheadache neurosensorial disturbance. This may be a series of idiopathic. Recurring neurological symptoms, which usually develops over a 5 – to 20 – min period and may last less than I hour. “Nausea is the complaint of the vast majority of patients; vomiting, in addition to nausea, occurs in just over one half of the patients. These gastrointestinal disturbances usually start sometime after the onset of the pain but occasionally precede the headache” A typical aura may consist of visual disturbances, hemisensory symptoms, hemiparesis, dysphasia, or combinations of these phenomena. Gradual development, duration of less than 1 h, and complete reversibility characterized thc aura, which is associated with this form of headache. Differential diagnosis of migraine headache includes myalgia, myositis or myofascial pain of the masticatory musculature. TMDs, and tooth pain.

Other forms of facial pain of vascular origin may include migraine of the midfacial region sometimes called lower-half migraine. Patients with this form of vascular pain report pain in the jaw and neck pcriorbitally and in the maxilla. There may be tenderness of the carotid artery therefore, this disorder is known as carotidynia (Fay, 1932). As with migraine, this condition predominately affects women. The symptoms are of a dull pain with superimposed throbbing that may occur once or several times weekly. Exacerbations may last minutes to hours. Differential diagnosis includes TMD, pain of the myofascial pain, and masticatory musculature and dental pain.